REVIEW: Bad Therapy

The field of pediatric mental healthcare needs a better understanding of health

Bad Therapy: Why the Kids Aren’t Growing Up by Abigail Shrier. Sentinel, 2024. 320 pp., $30.00

The kids, Abigail Shrier says at the outset of Bad Therapy, are not all right. Instead, they are reporting unprecedented levels of anxiety, depression, and other mental health disorders. In a nutshell, ours is the age of a “child mental health crisis.”  

What is going wrong? I’ll start with Shrier’s conclusion: The problem is the parents. Instead of affirmatively parenting their children through navigating life’s challenges, many moms and dads have stepped aside and let therapists, psychiatrists, and teachers take the lead in addressing child mental health. The results are dismal. Shrier finds that the excess of our current mental health interventions directed at children creates a sort of “emotional hypochondria” that prevents them from growing into responsible adults.

Shrier is careful to point out that she is not discussing children with severe mental health issues, such as young children removed from their families with terrible histories of abuse, or those suffering from schizophrenia or bipolar disorder. These children need and deserve excellent mental health care delivered by competent professionals. Rather, Shrier examines seemingly ordinary children and young adults who nevertheless are unable to cope with the normal pressures of life. They crumble when asked to take tests, deal with breakups, or navigate college applications. 

Others have blamed external factors for our children’s mental health difficulties—gun violence, global warming, abortion restrictions, and more. Shrier looks elsewhere: at the therapists who profess to treat these children, the parents blindly following the advice of therapeutic professionals, and the teachers adopting the roles of both therapist and parent. American society at large has adopted a “therapeutic culture” when it comes to children. Ironically, this very culture is damaging their mental health.

Shrier’s book immediately draws the reader in. Indeed, I stayed up reading until 3am the first night I opened it, despite having a nursing baby and older children. She deftly presents complex concepts in psychiatry and mental health in a way accessible to a non-expert. One of the most important concepts she introduces is the idea of iatrogenic harm caused by psychiatric treatment. 

Iatrogenesis is a disease or negative impact caused by medical treatment itself. For example, a patient who goes to the doctor risks being misdiagnosed with a heart condition, taking unnecessary medication with negative side effects, and suffering iatrogenic harm. Providing mental health treatment to children seems like it doesn’t have a downside. Even if it doesn’t help, many parents believe it can’t hurt. Shrier disagrees: “Therapy is no benign folk remedy. It can provide relief. It can also deliver unintended harm.”  

The unintended harm of modern therapy and the spread of these therapeutic ideals into wider society can be broken down into ten parts. Shrier calls this the “Ten Steps” of “Bad Therapy.”  First, kids are taught to pay close attention to their feelings. This moves the emphasis from action (where a child is trying to achieve a goal) to feeling, in which a child is encouraged to think about himself, encouraging “negative introspection.” Second, therapy can introduce “rumination,” in which a child ends up destructively brooding on past harms and injustices. Third, many children are taught to prioritize happiness, but also often get social rewards for telling their peers that they have mental health issues. Having happiness as a goal is counterproductive. Shrier contends that “the more vigorously you hunt happiness, the more likely you are to be disappointed.” At the same time, in 2024, attention and social cache are sometimes granted to kids and teens who publicly claim a mental health issue.  

Fourth, parents are encouraged to accommodate their children’s fears and worries. Fifty years ago, a child who refused to eat because he didn’t like what was served for dinner would probably be sent to bed hungry. Today, that same child might be diagnosed with “sensory issues” and be served a separate meal he prefers. Fifth, parents (and school counselors and therapists) are encouraged to constantly monitor children for “emotional damage.” This constant monitoring makes children fear—and then believe—there is something wrong with them.  

These first five “steps” Shrier identifies as contributing to the pediatric mental health crisis seem like common sense once she explains them. All are sobering, to be sure. But in considering these five factors, a course correction seems doable without radically changing the current state of mental health treatment for children. Not so for the next “five steps,” which involve the modern system of therapy and psychiatric drugs for children. Here, Shrier lays out a powerful argument for dramatically rethinking (and reducing) mental health interventions directed at children.

Shrier’s sixth identified step is the increasing number of mental health diagnosis attached to children. Today, engaged parents often seek out diagnoses when their children run into difficulties in school and social situations. But as Shrier points out: “Obtaining a diagnosis for your kid is not a neutral act. It’s not nothing for a kid to grow up believing there’s something wrong with his brain.” 

Shrier calls the seventh step simply “Drug ‘Em.” She writes that too many pediatricians and child psychiatrists will write prescriptions for Lexapro, Ritalin, Adderall, and other psychiatric drugs without serious consideration of whether it is truly necessary. Even if the drugs work as designed, Shrier argues, medicating young children is fundamentally different from medicating adults. It is critically important that children learn to deal with their own emotions and feelings. To the extent that psychiatric medication numbs children from fully experiencing their emotions, it sets them up to enter adulthood without developing their own internal scaffolding for facing the many inevitable tragedies of life.  

In step eight, kids are pressured to “locate any dark feelings and share them.” As it turns out, this is often not a good therapeutic technique, as repeatedly circling back to painful memories can make people feel worse. In step nine, teenagers and young adults are sometimes advised by therapists to break contact with “toxic” family. Numerous therapists—including some that have written best-selling books—claim that most adult unhappiness is traceable to childhood trauma. This is not true, but leads adult children to cut off their parents, breaking up families and separating family members from supporting each other. Finally, in step ten, therapists can create “treatment dependency.” This can mean a young child may be afraid to make independent decisions without the approval of a therapist.   

Shrier’s last five steps should be a wake-up call: The pediatric mental health industry is in desperate need of reform. Unless and until that happens, I would recommend her book to parents throughout the country. There are many terrible parenting books out there. There are infinitely more “parenting gurus” on Instagram, TikTok, and other social media platforms providing misleading or destructive advice. What Shrier’s book provides is a nudge to parents to feel empowered to ignore the so-called experts.  

This does not mean that no child needs mental healthcare. It means that parents are—absent some serious issue—the people best equipped to decide whether, how much, and what kind of mental healthcare their children truly need. Parenting is a tremendous responsibility, requiring good judgment, hard work, and careful attention to each individual child. Ignore social media. Reject the idea that your child is broken. Instead, Shrier calls on us—the parents!—to provide our children with the structure and boundaries they need to thrive, help them face adversity with resilience and courage, and love them unconditionally.  

Ivana Greco is a homemaker and homeschooling mother of three, as well as an attorney. She writes at: https://thehomefront.substack.com.